So now that the spring and summer allergy seasons are finally over, we should all we able to breathe easily, right? If only! Autumn and winter bring special breathing challenges for many Americans. Dry heat from central heating systems aggravate respiratory issues, and the air becomes even drier when homeowners use wood-burning stoves, space heaters, and fireplaces. When you add to this potent mix the negative effects of smoking tobacco products, breathing becomes more intense for smokers and nonsmokers alike, especially when driven indoors where windows in houses, offices and vehicles are closed up.

November is COPD Awareness Month and Lung Cancer Awareness Month. It’s not a coincidence that the two are recognized together. The primary cause of Chronic Obstructive Pulmonary Disease (COPD) is the inhalation of cigarette smoke. Up to 24 million Americans show impaired lung function, which is common among those with COPD, the third-leading cause of death in the United States. It’s a staggering number — more than 12 million Americans have been diagnosed with COPD, while an estimated 12 million more have it, but have not been diagnosed.

Beyond the inhalation of cigarette smoke, other causes of COPD include exposure to occupational dust particles and chemicals, as well as a rare genetic mutation called Alpha-1 Antitrypsin Deficiency. Also known as emphysema and chronic bronchitis, COPD is a lung disease characterized by an obstruction to airflow that interferes with normal breathing and over time makes it very difficult to breathe. COPD is not curable; however, it is preventable, and can be treated and managed effectively, particularly when the disease is diagnosed early.

People at risk of COPD, especially current and former smokers with COPD symptoms, should consult their physicians about a simple and painless spirometry test in order to diagnose the disease as early as possible and begin treatment.

Here is a short list of signs you should watch for if you think you or someone you know may be suffering from COPD:

Constant coughing, sometimes called “smoker’s cough”

Shortness of breath while doing everyday activities

Producing a lot of sputum (also called phlegm or mucus)

Feeling like you can’t breathe or take a deep breath

Wheezing

If you have been diagnosed with COPD, there are several steps you can take to improve your health and longer-term quality of life. The most important is to quit smoking immediately. Based on your doctor’s recommendations, you should take medications as prescribed and keep as physically fit as possible. Keeping active is essential for improved breathing function, and pulmonary rehabilitation can help you rebuild strength and reduce shortness of breath.

Tips to Stop Smoking

Since the smoking of tobacco products is the culprit responsible for many cases of COPD, eliminating smoking is the best way to mitigate or prevent COPD. Here are simple tips to help you stop smoking:

Talk to your doctor or pharmacist about the various types of treatments and different over-the-counter and prescription medications that are available to help you quit smoking.

Look into the different options available to help smokers quit. Visit lung.org/stopsmokingor call 1-800-LUNG-USA (1-800-586-4872) for suggestions.

Take time to plan. Pick your quit date a few weeks ahead of time and mark it on the calendar. If you can, pick a day when life’s extra stresses are not at their peak, such as after the holidays. Mark a day on the calendar and stick to it. As your quit day approaches, gather the medications and tools you need and map out how you are going to handle the situations that make you want to smoke.

Get some exercise every day. Walking is a great way to reduce the stress of quitting. Exercise is proven to not only combat weight gain but also to improve mood and energy levels.

Eat a balanced diet, drink lots of water and get plenty of sleep.

Ask family, friends and co-workers for their help and support. Having someone to take a walk with or just listen can give a needed boost.

You don’t have to quit alone. Help is available online and in most communities, and there are a variety of smoking-cessation programs available to help.

It’s also important to educate yourself. The American Lung Association has a wealth of information and resources to help you better understand how your lungs work, and about COPD. You can reach them at 1-800-LUNG-USA, and find online support at www. lung.org.

Parachuting into a large farm compound, the avatar dropped down onto a wood pile and started bashing his way through a wall with a large pickaxe. The axe changed into an automatic rifle as the avatar charged through the barn and out into a corral. Spotting another figure at the entrance to a barn, the two exchanged fire, and dodging behind a wall, the player controlling the avatar called for assistance as another group of avatars came around the corner and headed to cut off the other player. Running blindly toward the barn, he watched as a second group of avatars suddenly appeared to confront them, and “deceased” appeared on the screen. The player – a 15-year-old boy — shrugged, spoke to his friends on his headset, and with his character again activated, returned to the action.

Around the world, 2.6 billion people play video games, including two-thirds of American households, according to the Entertainment Software Association. But “gaming” isn’t necessarily as benign as many people – and the gaming industry – would claim. Yes, it may heighten eye/hand coordination and teach intuitive online skills, but it also is distracting, can lead to or exacerbate moodiness, anxiety and depression, and is now being classified as addictive behavior, similar to gambling, compulsive spending or eating and other behavioral problems.

Now, the World Health Organization (WHO) is saying players can actually become addicted. The reason for the “addictive” label is because some players allow gaming to consume their days, often at cost to schoolwork, jobs, recreation and relationships. They may become withdrawn and antisocial, turn to their gaming world for social contact, and elect to avoid doing many other activities that might once have been their normal routine. As such, WHO has added “gaming disorder” to their International Classification of Diseases, the highly respected listing of medical conditions.

Video game addiction is described as an impulse control disorder which does not involve use of an intoxicating drug and is very similar to pathological gambling. Video game addiction has also been referred to as video game overuse, and pathological or compulsive/excessive use of computer games or video games. Statistics show that men and boys are more likely to become addicted to video games versus women and girls. Recent research has found that nearly one in 10 youth gamers (ages 8 to 18) can be classified as pathological gamers or addicted to video-gaming.

Those suffering from video game addiction may use the Internet to access massive multi-player online role-playing games (MMORPGs) and multi-user domain games (MUDs). MMORPGs are networks of people, all interacting with one another to play a game to achieve goals, accomplish missions, and reach high scores in a fantasy world. MUDs combine elements of role-playing games, fighting, and killing in a social chat channel with limited graphics. Some of the most popular on-line games include EverQuest, Ultima Online, World of Warcraft, Final Fantasy, Vanguard, Fortnight, Overwatch, Call of Duty, and City of Heroes. Most MMORPGs charge monthly subscription fees, but some are free.

Mental health professionals are concerned about the harmful aspects of technology, overall, and are urging parents and consumers to look for ways to scale back usage of social media and online entertainment. Gaming addiction side effects, they stress, are not dissimilar to what they see in cocaine addiction. And therapists say they increasingly see players who have lost control to a wide variety of online and purchased games, from Minecraft to Candy Crush Saga.

Recognizing and Responding to Gaming Addiction

Unfortunately, the video game industry is expanding so quickly that medical research has struggled to keep up. An older study published in 2009 found that nearly nine percent of young players were addicted to their games. Many experts believe that the number has increased as games have become more advanced, more social and more mobile.

Some mental health professionals believe that gaming disorder is not a stand-alone medical condition. Rather, they see it as a symptom or a side effect of more familiar conditions, such as depression or anxiety. Common symptoms they point to from game use include jeopardized or risked loss of significant relationships, job, educational or career opportunities; lying to family members, friends or professionals to conceal the extent of their involvement with games; and use of games to escape from problems or to relieve feelings of anxiety, depression, guilt or hopelessness.

Additional warning signs for children and teens include:

Fatigue, and tendency to fall asleep during school

Not completing homework or assignments on time

Declining grades, or failing classes

Dropping out of school activities, clubs, sports, etc.

Isolating from family and friends to play video games

Many people attempting to quit or reduce gaming use experience withdrawal symptoms including anger, depression, relief, fantasies about the game, mood swings, anxiety, fear, irritability, sadness, loneliness, boredom, restlessness, procrastination, and upset stomach. Being addicted to video-gaming can also cause physical discomfort or medical problems such as Carpal Tunnel Syndrome, dry eyes, backaches, severe headaches, eating irregularities such as skipping meals, failure to attend to personal hygiene, and sleep disturbance.

Verbal communication is an important tool in addressing gaming addiction, with the goal of getting the affected individual to recognize his or her compulsive behavior and take steps to reduce it. If you’re a parent, monitoring your child’s development is important. You can help your growing child learn how to overcome problems in real life rather than giving up and relying on fantasies in games. To accomplish this, you can implement a reasonable schedule for times when playing games is allowed. Alternatively, you can replace gaming with another pastime. You can also teach your teens to consider playing games as a reward whenever they successfully resolve personal problems in real life.

Patience is always an important virtue when you’re helping someone recover from video game addiction. Find ways to counteract any negative reactions that the addict may exhibit. For instance, if the urge to go back to gaming is very strong, create distractions through sports and other strenuous activities. With the right responses to withdrawal symptoms, the addicted player may reduce or let go of gaming and get back to healthy living. Additionally, many professionals have been trained to help teens and adults recover from addiction.

If you or someone you know is behaving like a gaming addict, learn to limit game time to a specific duration per day so that the remaining hours of the day can still be used for other activities. You can choose between therapies, and certain medications can also help to inhibit compulsive behaviors. If the addiction is the result of another underlying problem, therapy can also address this other issue and teach the addict how to cope with conditions such as depression, stress and anxiety.

Since research efforts devoted to video game addiction are relatively small compared to those for other addictions, very few support groups are available to provide communal assistance. One of the more notable groups is the Online Gamers Anonymous, a nonprofit organization that offers a 12-step program for recovery from video game addiction.

There’s no question that drinking water regularly is important for our health. Remaining properly hydrated allows our body to work to its full potential, processing food, using and storing energy, ensuring healthy blood production, protecting our muscles and organs, supporting removal of waste and for natural cleansing. But the source of the water we choose to drink can be questionable, and recent revelations – including the abysmal failure of the public water system in Flynt, Michigan – have raised concerns about the quality of our water.

Taste and convenience play important roles in our choice of water sources. While public water systems, by and large, are safe and healthy, some people fear contaminants or determine they don’t like how their local water tastes. Many others choose to buy a wide variety of bottled waters available in stores, restaurants, at sporting events, convenience locations or wherever people gather. While convenient, bottled water is hugely more expensive than tap water and – to the surprise of many and the chagrin of advertisers (15 percent of the cost of bottled water goes to marketing) – not necessarily as healthy as public or private water sources.

In fact, bottled water may be hurting our health. Studies indicate that plastic bottles release small amounts of chemicals over long periods of time. The longer water is stored in plastic bottles, the higher the concentration of a potentially harmful chemical. The research involved 132 brands of bottled water from 28 countries produced in containers made from polyethylene terephthalate, or PET.

Research found that the concentration of certain chemicals, such as antimony, increases the longer the water sits in the plastic bottle. It increases over time because the plastic is leaching chemicals into the water. Antimony is a white metallic element that in small doses can cause nausea, dizziness and depression. In large doses, it can be fatal. Antimony is similar chemically to lead. It is also a potentially toxic trace element.

Adding to those concerns, researchers have set off new alarms: A recent study carried out on more than 250 water bottles sourced from 11 brands in nine different countries revealed that microplastic contamination (tiny pieces of plastic) was nearly universal, found in more than 90 percent of the samples surveyed.

Conducted by journalism organization Orb Media and researchers at the State University of New York at Fredonia, it was discovered that an average of 10.4 microplastic particles about the width of a human hair was present per liter. That’s about twice the level of contamination discovered in the group’s earlier study on plastic contamination in tap water across the globe, with the highest rate found in the United States. Studies also have linked a large portion of the microplastic particles found in our oceans, lakes and rivers – as well as in fish stomachs – to the washing of synthetic clothes.

In the case of bottled water, Orb’s new study indicated contamination was partly the result of plastic packaging, and partly the fault of the bottling process. The survey included brands like Aquafina, Dasani, Evian, Nestlé and San Pellegrino. What researchers don’t know is the effect these tiny pieces of plastic have on our long-term health. Much of it could pass harmlessly and be disposed as waste, but it also can become lodged in our digestive or lymphatic systems.

Who’s Watching Our Water?

Defined as a “food” under federal regulations, bottled water is under the authority of the Food and Drug Administration (FDA) while the Environmental Protection Agency (EPA) – under much stricter standards – regulates tap water.

The EPA mandates that local water-treatment plants provide city residents with a detailed account of tap water’s source and the results of any testing, including contaminant level violations. Bottled water companies are not required to do this reporting. Also, while municipal water systems must test for harmful microbiological content in water several times a day, bottled water companies are required to test for these microbes only once a week.

Additionally, public water systems are required to test for chemical water contaminants four times as often as bottled water companies. Compounding the issue, loopholes in the FDA’s testing policy do not require the same standards for water that is bottled and sold in the same state, meaning that a significant number of bottles (almost 70 percent are processed in the state where they are sold) have undergone almost no regulation or testing.

There are other important factors to consider before you choose your water: Bottled water produces up to 1.5 million tons of plastic waste per year. That plastic requires up to 47 million gallons of oil per year to produce. And while the plastic used to bottle beverages is of high quality and in demand by recyclers, over 80 percent of plastic bottles are simply thrown away. Most of our plastic bottles end up in landfills, where they take years to decompose. Worse, thousands of tons of plastic each year end up in our oceans, polluting, destroying fish, killing birds and compromising delicate ecosystems.

Drink Up

So, what’s the solution? Certainly, it isn’t to drink less water! The safe, environmentally friendly and economic answer is to buy thermoses or safe, sturdily constructed neoprene or other refillable plastic or stainless-steel water bottles that don’t contain contaminants or decompose quickly.

Ironically, blind taste tests conducted throughout the United States almost always result in consumers preferring tap water to bottled water. Also, for additional protection or to enhance taste, inexpensive carbon-based filters are available in most stores and can be used to easily filter tap water; filters also are sold that attach directly to your kitchen faucets.

When you consider the environmental costs, and the cost to your pocketbook, it’s an easy decision to go natural over bottled. If the health options alone aren’t enough to convince you, bottled water costs 240 to over 10,000 times more per gallon than tap water. Most municipal water costs less than 1 cent per gallon. Think about that the next time you plunk down a few bucks for a bottle of convenient – but potentially dangerous – bottled water.

Raise your hand if you typically ignore the tiny little writing on your prescription medication bottles or on the box that comes with your over-the-counter meds. You are not alone because according to medical researchers, millions of Americans—by some estimates, half or more of the people using medications or drugs – ignore the warning labels, either partially or completely.

Medical compliance broadly applies to how well you adhere to the directions, warnings, and advice you’ve received from your physician, pharmacist, or the drug company. It concerns frequency, dosage, time of day for taking a medication, and what foods, other medications or liquids to avoid when using certain drugs.

While it may be hard to imagine that food would play such an important role in how well our medications work, think vitamins, digestion, compounds, and chemicals . . . . lots and lots of chemicals. That’s what food and the medications we ingest, inhale, or otherwise insert into our bodies are made of. How they work together – and if they work well together – is important information for medical consumers to understand and employ. Failure to comply with these warnings can minimize the effectiveness of the medications you are taking and, in some cases, endanger your life.

The range of foods that can counteract, boost, or reduce medicinal potency are far reaching. Some may be surprising — the list includes everyday items such as bananas, kale, grapefruit, black licorice, caffeine, alcohol, salami, and walnuts, just to name a few. Here’s a rundown on some common food/drug interactions consumers should be aware of:

Bananasshouldn’t be mixed with ACE inhibitors and so-called “potassium-sparing” diuretics, which can increase the amount of potassium in our bodies. Too much potassium can cause an irregular heartbeat and heart palpitations. So people who take those drugs should avoid large amounts of food high in potassium, including bananas, oranges, green leafy vegetables, and salt substitutes such as Morton Lite Salt. The meds that fall into these categories include captopril (Capoten), enalapril (Vasotec), and lisinopril (Prinivil, Zestril), which are used to lower blood pressure or treat heart failure. Also avoid mixing with certain diuretics, such as triamterene (Dyrenium), used to reduce fluid retention and treat high blood pressure.

Kale shouldn’t be mixed with blood thinners such as warfarin (Coumadin). Kale and other greens, including broccoli, cabbage, spinach, and brussels sprouts are rich in vitamin K, which can reduce the drug’s anti-clotting effects. It’s good to eat a balanced diet with lots of greens, but if you have the urge to start drinking a daily kale smoothie, speak with your doctor first.

Black licorice shouldn’t be mixed with Digoxin (Lanoxin), which is used to treat heart failure and abnormal heart rhythms. Glycyrrhizin, a component of black licorice, can cause irregular heartbeat or even death when combined with digoxin. Licorice also appears to make certain drugs less effective. The list includes blood-pressure medications, blood thinners, pain relievers, and birth-control pills. Be careful if you eat a lot of it (only the real stuff counts; some candy is just licorice-flavored, so look for “licorice extract” on labels) or if you take licorice-root supplements for heartburn.

Grapefruit juice shouldn’t be mixed with cholesterol drugs such as atorvastatin (Lipitor) and lovastatin (Mevacor). Drinking grapefruit juice can raise the level of the drug in your bloodstream and increase the risk of side effects, especially leg pain. Grapefruit and grapefruit juice can interfere with other drugs, too.

Walnuts shouldn’t be mixed with thyroid drugs such as levothyroxine (Levothroid, Levoxyl, Synthroid). Walnuts, soybean flour, cottonseed meal, and high-fiber foods can prevent your body from absorbing those medications. So if you eat a high-fiber diet, you might need a higher dosage.

Milk shouldn’t be mixed with Tetracycline antibiotics (Sumycin). Calcium, which we derive from dairy foods such as milk, yogurt, and cheese, and calcium supplements and fortified foods can prevent the body from absorbing the drug. In general, tetracycline works better if taken one hour before or two hours after eating.

Salami shouldn’t be mixed with drugs such as metronidazole (Flagyl) and linezolid (Zyvox), used to treat bacterial infections. If you eat or drink too much of anything that contains the amino acid tyramine, your blood pressure could spike. Tyramine is found in foods that are aged, pickled, fermented, or smoked such as processed cheeses, anchovies, and dry sausage. It’s also in avocados, bananas, chocolate, and alcoholic drinks.

Alcohol doesn’t mix well with most medications. Many medications come with instructions not to drink alcohol while you’re taking them. It’s an important warning—even a single glass of wine could be too much. Alcohol alone can make you drowsy, light-headed, and less coordinated; mixing it with certain drugs can magnify those effects. Even worse, it can cause serious problems, including internal bleeding and breathing and heart problems. And alcohol can make a drug less effective, even useless, or it can make a drug toxic. For example, just a few drinks mixed with acetaminophen (Tylenol) can damage your liver.

Finally, beware of mixing supplements with your prescription and over-the-counter medications without consulting your physician or pharmacist. Like the foods and drinks above, some dietary supplements, including vitamins, minerals, and herbals, can cause problems if you take them with some drugs.

Even a multivitamin with iron can negate the effects of many drugs. But herbs are the worst offenders. For example, combining St. John’s wort with over-the-counter cough medicines or prescription antidepressants or migraine drugs can cause serotonin syndrome, a dangerous condition that can cause rapid blood-pressure changes, confusion, muscle spasms, and even death.

The most common drugs involved in negative interactions with supplements were, in order, warfarin (Coumadin), insulin, aspirin, digoxin (a heart drug), and ticlopidine. The supplements that most often caused problems were St. John’s wort, magnesium, calcium, iron, and ginkgo biloba.

Just because these foods and supplements might interact with certain drugs you’re taking doesn’t mean you have to avoid them completely. Speak with your physician about any short- or long-term medication you’re taking, read labels carefully, and learn when it’s safe to eat what you like, when you like it.

When you stop to consider that most of the earth is covered by water, it’s a wonder that our diets aren’t primarily made up of seafood. But we’re land dwellers, and it’s far easier to chase something on the ground or dig it out of the garden than to rustle up dinner from the ocean. Still, fish are an inherently healthy food source — or were, at least, before we started polluting the world’s oceans, rivers and lakes. Much of our “fresh” fish is now farmed, as well, and can be treated with antibiotics or fed contaminants that aren’t good for us in larger quantities.

So how do we know what is safe to consume, how much, and when it’s good or bad for us?

Fish is a good source of protein and, unlike fatty meat products, it’s not high in saturated fat. Fish also is a good source of omega-3 fatty acids. Omega-3 fatty acids benefit the heart of healthy people and those at high risk of — or who have — cardiovascular disease. Research has shown that omega-3 fatty acids decrease risk of arrhythmias (abnormal heartbeats), which can lead to sudden cardiac death. Omega-3 fatty acids also decrease triglyceride levels, slow the growth rate of atherosclerotic plaque and lower blood pressure.

Fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna are high in two kinds of omega-3 fatty acids which have demonstrated benefits at reducing heart disease.

That’s all positive. But here’s the negative: Some types of fish may contain high levels of mercury, PCBs (polychlorinated biphenyls), dioxins and other environmental contaminants. Levels of these substances are generally highest in older, larger predatory fish and marine mammals.

The benefits and risks of eating fish vary depending on a person’s stage of life:

Children and pregnant women are advised by the U.S. Food and Drug Administration (FDA) to avoid eating those fish with the potential for the highest level of mercury contamination (e.g., shark, swordfish, king mackerel or tilefish); to eat up to 12 ounces (two average meals) per week of a variety of fish and shellfish that are lower in mercury (e.g., canned light tuna, salmon, pollock, catfish).

For middle-aged and older men and postmenopausal women, the benefits of eating fish far outweigh the potential risks when the amount of fish that are eaten is within the recommendations established by the FDA and Environmental Protection Agency.

Eating a variety of fish will help minimize any potentially adverse effects due to environmental pollutants.

Nutritional experts recommend eating fish (particularly fatty fish) at least two times (two servings) a week. Each serving should be approximately 3.5 ounces cooked, or about three-quarters of a cup of flaked fish. Enjoy fish baked or grilled, not fried. Choose low-sodium, low-fat seasonings such as spices, herbs, lemon juice and other flavorings in cooking and at the table.

For many people, tuna is a lunchtime staple. The FDA and EPA continue to recommend that no more than six ounces of fish per week (of your 8 to 12 ounces weekly) should be white (albacore) tuna. Although canned light tuna is lower in mercury, albacore tuna has more of it.

Five of the most commonly eaten fish or shellfish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish.

Avoid eating shark, swordfish, king Mackerel, or tilefish because they contain high levels of mercury. Also, be careful when buying canned seafood, as cans often are lined with a BPA-plastic coating. Look for seafood packed in shelf-stable, flexible pouches, as this is the environmentally preferable packaging.

Regardless of your age or gender, check local advisories about the safety of fish caught by family and friends in local lakes, rivers and coastal areas. If local advice isn’t available, you should eat six ounces or less of these locally caught fish per week, and children should eat no more than one to three ounces per week. Then avoid eating other fish for the rest of the week.

Potential exposure to some contaminants can be reduced by removing the skin and surface fat from these fish before cooking. Consumers should also check with local and state authorities about types of fish and watersheds that may be contaminated and visit the FDA website for the most up-to-date information on recommendations for specific subgroups of the U.S. population such as children and pregnant women.

Last, but not least, another important consideration when you consume fish should be about environmental sustainability. Some varieties of seafood have been overfished or caught in ways that may cause lasting damage to our oceans and marine life. Here are some basic rules to make smart seafood shopping choices that are good for your health and the health of our oceans.

Eat fish that are lower on the food chain – typically, smaller fish are more plentiful and contain less mercury.

Know how sustainable your seafood choices are. This link to the Monterey Bay Aquarium’s Seafood Watch guide provides valuable information on which fisheries provide the most sustainable seafood choices, based on health and a variety of other measurements.

Buy American. The United States has stricter fishing and farming standards than do other parts of the world.

Know how it’s caught. Hook and line is a low-impact method of fishing that does not damage the seafloor and let’s fisherman use intelligently designed traps and throw back unwanted species.

Eat Local. You’re usually better off eating the local variety of a particular type of fish instead of its counterpart from across the country or another part of the world, unless that species has been depleted in local waters. Even out of season, the local fish that has been frozen is preferable, since fresh fish must be transported by air, the most energy-intensive method of shipping.

Look for the label. The Marine Stewardship Council certifies seafood that is caught or raised in a sustainable, environmentally friendly manner. Items that meet its criteria are marked with a MSC-certified label.

Generational forces are driving socio-economic changes in lifestyles and families that are contributing to stress and negatively affecting our health and wellbeing. One prime example is the pressures faced by Baby Boomers as they come of age and, in many cases, find themselves faced with caretaker burdens that “sandwich” them between supporting their children, themselves, and aging parents.

It is estimated that American families provide 80 to 90 percent of all in-home long-term care services for their aging family members, disabled adult children, and other loved ones. These services may include assistance with activities of daily living, medical services coordination, medical supervision, administration of medications and assistance with financial, legal, spiritual and emotional concerns. These family caregivers often go unrecognized and are typically over-utilized. Focusing on their children, parents, and jobs, their own needs often go unfulfilled, which leads to additional stress.

Typically the American “Sandwich Generation” caregiver has been a woman in her mid-forties, married, employed and caring for her family and an elderly parent, usually her mother. Today, however, there are more and more men finding themselves in a caregiving role as well, and often they are squeezed in between the generations.

The demanding role of being multi-generational caregivers spreads across all racial, gender, age and ethnic boundaries. Some of the common stressors that affect both urban and rural sandwich generation caregivers are:

Splitting time between children/family and elder loved ones

Finding time for each caregiving role

Finding time for marriage or a significant other

Finding time for yourself

Not falling behind in your work or bringing your home stress to the work place

Keeping generational peace between children and elder loved ones

Finding the resources needed to care for family members

Combating feelings of isolation

Dealing with all the guilt associated with not having enough time to accomplish all that “should” be done.

Related challenges include geographic barriers to resources, and isolation from other caregivers, family members or informal supports. The lack of service or care network availability, especially burdensome outside of cities, can add to caregiver stress, burnout, and depression. Solving these issues and controlling related stress and health factors is critical, though not easy – it requires adjustments on both sides, establishing boundaries, and setting priorities that include time for yourself, empathy and outreach to others. If you’re “sandwiched,” here are a few tips to help achieve better balance:

Regular “team” communication. Consider having a weekly family meeting where you discuss upcoming events, responsibilities, issues and opportunities. This gives everyone in the family the opportunity to discuss what’s on his or her mind in an open, safe environment. Use this forum to discuss the many different caregiving tasks that need to be accomplished each day or week.

Set a family weekly or monthly task list. Set mutual expectations for how the many tasks of caregiving will be accomplished. Caregiving often becomes a one-person show but it does not need to be if you have family support.

Ask for assistance. Make a point of picking up the telephone and spending time calling resources such as your local area Agency on Aging, hospital, a social worker, a physician or a local church or temple. There are a variety of services available in most communities and cities. Many can be found on the internet or simply by talking with other caregivers, social service agencies, behavioral health centers and related professionals.

Take time to care for yourself. Sandwich generation caregivers become run down and sick because they have not taken time to care for themselves. You can’t care effectively for your loved ones if you don’t care for yourself, as well. Here are some useful hints to help make sure you focus on your own needs as well as those you are caring for:

Take time every day to “check-in” with yourself, even if it is only for half an hour. This should be your protected time. Enjoy this time by reading, listening to music, exercising or whatever you like to do.

Remember to take time to laugh, talk with friends, and eat properly, especially nutritious food rather than prepared foods high in fat, sugar and salt.

Take time to be “in” your marriage or relationship.

Try to “be present” at work as much as possible… our jobs exercise our creativity and usefulness in different ways, and association with others outside the home is valuable, emotionally.

Listen to your body – if it’s telling you to slow down, or that something is not right, seek medical advice. Also seek assistance from a therapist or professional counselor versed in caretaker stress.

Every caregiver and caregiving situation is unique, but there are always common factors bridging situations and caregivers. Support can come from many different sources and in many different ways as long as you seek it out and remember, always, that taking care of yourself is your most important job.

According to a new survey from Aon Hewitt, the National Business Group on Health, and The Futures Company, as employers explore new ways to create and maintain a healthy and productive workforce, employees who perceive their organizations as having a strong culture of health are happier, less stressed and more likely to take control of their well-being than employees in other organizations.

For the third straight year, these organizations surveyed more than 2,700 employees and their dependents covered by employer-sponsored health plans to determine their perspectives, behaviors and attitudes towards health and wellness. While the survey – called the Consumer Health Mindset survey* – focused on large employers, the information is largely applicable to medium- and small-sized employers, as well.

The report analyzed the responses of employees who work at organizations with strong cultures of health – or organizations that prioritize and encourage healthy behaviors in the workplace – and compared them to employees’ responses in organizations that do not.

Based on survey analysis, employees who work in strong cultures of health were more likely to say they have control over their health than those who work at companies where it is less of a priority (75 percent versus 63 percent). In addition, they were less likely to report that stress has a negative impact on their work (25 percent versus 49 percent). The report also showed a link between strong health cultures and general happiness. Sixty-six percent of employees in strong health cultures say they are extremely or very happy with their lives compared to just 32 percent of those in weak health cultures.

Small efforts can produce large returns

There are many ways for employers to foster a culture of health and wellness. This month, we’ll focus on how employer encouragement and commitment focused on charity walks, runs and other athletic events can benefit employee morale, improve teamwork, boost health and wellness, and do good by increasing participation, raising awareness and raising funds for important charities and health-related benefit activities.

Now is the time to research and sign-up for a variety of charity events held in the spring across Connecticut. Employers should encourage their employees to find the events and activities they’d most like to support or participate in, and then – through financial underwriting, time for practice and involvement, sponsorship, or general cheerleading – make it easy for them to follow through, either individually or as teams. There also are non-athletic activities, such as helping Fidelco raise, train, maintain and support guide dogs for the blind – that bring people together and promote teamwork by working toward a common cause.

To get you started, here is a small listing of several popular and well-known charitable events held annually in Connecticut. Whether you support these or many other worthwhile charitable options, now’s the time to start. Choose one or more that work for you and your staff, get involved, and everyone wins!

If you’re not enjoying the benefits of a wellness program at your company, join CBIA Healthy Connections at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Summer’s wrapping up quickly. The days are getting shorter and school is right around the corner. You and your employees are probably reliving your vacations and wondering where the time went. As the hot weather starts to wane and attention spans lengthen, it’s a great time to revisit your wellness planning to ensure continuity and keep your workforce focused and motivated about their health.

To reduce costs, employees need to become engaged in both their healthcare spending and in reducing their health risks. A standard approach is to focus on wellness, education, and consumer support by weaving wellness into the fabric of your company’s culture.

While one obvious goal of any wellness program is to reduce costs, it is not the primary message. Wellness is about improving health and quality of life. Successful programs place heavy emphasis on personal outcomes. Employees benefit from access to healthcare education and information on topics ranging from stress management and exercise to healthy cooking. They also benefit from smoking-cessation courses and materials, and through an understanding of their own personal responsibility in ensuring their health and wellness.

Making connections between costs and choices

When you integrate wellness and intervention programs, you have the opportunity to educate employees about how the connections between their healthy behaviors and lifestyle choices relate to their premiums and other healthcare costs.

The impact of health data and supportive outreach to drive changes is working for employers across the country. There are a variety of interactive, online wellness programs that can help employers enhance the health and productivity of their employees and support a more complete system of care.

If you’re not there yet, the first step is encouraging your team to complete an in-depth health assessment. This assessment yields revealing, yet actionable information for the individual, and can be used to help guide the employee to programs and actions that will address his or her health needs.

Quality educational courses and materials, sensible fitness activities, and effective communication are all core components of a successful wellness program. Employers must make the connections between medical costs, health risks, and personal responsibility. The more we understand that health risks, many of which are modifiable, drive health utilization and cost, the more effective we can be in helping our employees adjust their behaviors and attitudes toward wellness.

If you’re not enjoying the benefits of a wellness program at your company, join CBIA Healthy Connections at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Last time you were prescribed an antibiotic, did you take every pill in the bottle or packet as directed, or take them for the recommended number of consecutive days? Or, like millions of medical consumers, did you take them the first few days and then stop when you were feeling better?

Do you remember to take your blood pressure pills, cholesterol meds, or other prescriptions every day? Are you eating what you need to eat or avoiding what you shouldn’t be eating, again per your physician’s recommendations? Did you stop smoking yet, or cut back on caffeine and alcohol? Do you visit a doctor annually for a full physical or for recommended preventive screenings based on your age and gender?

This isn’t a lecture, it’s pointing out a dangerous reality shared by many of us – the failure to comply with pharmaceutical or medical recommendations…or to even understand them.

Truth is, more than one in four Americans don’t follow their physicians’ guidance. That’s a huge problem, and in the case of medications – where the number of non-compliers is even higher – failing to take prescriptions as prescribed is common, costly, and can be deadly. Medicines are an important part of treatment for serious infections. They can help relieve pain and lift depression. They also can help combat some of the nation’s leading causes of death and disability by helping control many common chronic diseases and lower the complications associated with them.

Consider these statistics on just Rx non-compliance alone:

75 percent of patients sometimes fail to take their medications as directed.

33 percent of prescriptions are never filled.

50 to 60 percent of the time, patients with chronic conditions do not take their medications.

33 to 69 percent of medication-related hospitalizations are linked to drug noncompliance.

125,000 patient deaths each year are linked to drug noncompliance.

$290 billion is spent annually on care needed because of medication noncompliance.

Why we don’t comply and how to improve our odds

There are dozens of reasons for why we don’t take our medications as prescribed. We forget to take them. We leave them at home. They upset our stomachs or make us drowsy. They cost too much. They taste lousy. They’re hard to swallow. Or, we don’t understand why we’re taking them or how they help us, so we don’t take it seriously. It also could be because of cultural issues, language problems, or literacy challenges.

Taking medications on time and correctly is extremely important. When we don’t take medications as prescribed, they may not work as well as they should, or we may have a greater risk for side effects. Also, many drugs work over a longer period and in less obvious ways. People who don’t take their blood pressure or cholesterol medications may feel well, but their blood pressure or cholesterol numbers may be rising. That can increase their risk for heart attack or stroke.

Here are tips to help medications work safely and effectively:

Gather information. Request brochures and pamphlets from your doctor’s office about a condition and medication. Ask your doctor to recommend reliable websites that may help. Your nurse-information service is another good resource, if you have access to one.

Make a list of your medications. Include all medicines, vitamins, supplements, and herbal remedies that you use. Share this list with all your doctors and your pharmacist, and keep it up-to-date. This makes it easier for medical professionals to spot – and hopefully prevent – potentially dangerous drug interactions.

Don’t rely on your memory. Buy a special pill case that’s divided into the days of the week. Then keep it somewhere in plain sight but safe from children. Newer boxes have built-in alarms. Also, take your medication at the same time every day, like when you brush your teeth or feed the dog. Set your watch or cell phone alarm to go off when you need to take a dose. Even a note on the refrigerator may help you remember.

Talk with your doctor. Before you stop taking a medication or start taking fewer doses to save money or simplify your schedule, call your doctor – even if symptoms disappear or you don’t think the medicine is working. Suddenly stopping some medications can be dangerous.

Ask about a simpler schedule. If you just can’t keep track of all your medications and when to take them, ask your doctor for help. With some medications, you may be able to switch to a different dose that doesn’t need to be taken as often.

Explore more affordable options. Prescriptions can take a big bite out of your budget, even if your health benefits include drug coverage. But, taking less medication or skipping doses isn’t a safe way to save money. If you’ve been prescribed a brand-name medication, ask your doctor about using a generic instead. It will have the same active ingredients as its brand-name version but may cost less. Some pharmacies and drug companies offer discount cards. Additionally, you may be able to buy a larger dose and split it to save money. It may be cheaper, for instance, to buy 200 mg tablets and break them in half if you only need 100 mg. But ask your pharmacist because selected medications are not safe to split apart.

Taking your medication as directed is just one part of a comprehensive strategy for staying healthy. Ask questions if you’re not sure what you’re taking and why you’re taking it, and especially if you’re in doubt about instructions.

Taking prescription and over-the-counter medications can be confusing and even dangerous if you are already taking supplements or other prescription drugs or supplements without your physician’s knowledge. Compliance with directions for taking each medication is critical, and following these simple steps and procedures can help prevent mistakes, potential overdoses or negative drug interactions.

Always accept the offer to speak to a pharmacist on each new prescription (Pharmacists are required to provide counseling upon request by the patient and are required to make an offer to counsel on each new prescription).

Look at the label

Is this your medication?

Does your name appear on the label?

Is it the right medication?

Open the bottle

If it looks different ask the pharmacist why

Be familiar with both brand and generic names of your medication

Know the size, shape and color of your medication

Be sure you know the purpose and dose of your medication, how often you should be taking it and whether you should take it with or without food.

Ask if there are any side effects, or whether you should avoid any activities, foods or other medications (like supplements or over-the-counter remedies).

Ask what you should do if you miss a dose (don’t double up). Pill reminders are often helpful.

Try to get all your medications at the same pharmacy to enable the pharmacist to cross-check your records for medication interactions.

Tell your pharmacist what other medications you are taking, including herbal remedies.

What should patients do if they think there has been an error in their medication?

Never take any medication if you suspect an error has been made

Immediately contact the pharmacy and ask to speak to the pharmacist alerting them that you believe there may be an error with your medication

After speaking with the pharmacist, if you believe a mistake has been made, call your physician right away.

Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. Employees in this program have access to tools and information that can help improve their overall physical and mental well-being. The program is free to both you and your employees as part of your participation in CBIA Health Connections!